Surgical field contamination analysis in various artificial joint arthroplasties

Abstract

Purpose: Joint arthroplasty has shown favorable outcomes across various anatomical sites; however, complications such as peri-prosthetic joint infection (PJI) remain challenging. Despite the importance of understanding surgical field contamination, many details are unclear. This study aimed to evaluate the contamination status of the surgical field during joint arthroplasty procedures. Methods: A prospective study was conducted on 150 joint arthroplasty cases at a single institution, involving 38 men and 112 women with a mean age of 68.8 years. The cohort included 41 total shoulder arthroplasty (TSA), 31 total knee arthroplasty (TKA), and 78 total hip arthroplasty (THA) procedures. Bacterial cultures, including anaerobic cultures, were obtained from three sites: (1) the surgical scalpel immediately after skin incision; (2) the surface of the surgical tray where the instruments were placed at the end of the procedure; and (3) the hands and chest area of the surgeon's gown. Results: No early PJIs or bacterial growth was observed post-surgery. However, bacterial contamination was detected in 7 cases (4.7%), primarily in surgical trays. Cutibacterium acnes was identified in two TSA cases and one case each of TKA and THA. Other bacterial species detected included Staphylococcus hominis and Corynebacterium species. Additionally, Micrococcus luteus was found on the surgical gown of one TKA case. Contaminated cases showed significantly higher body weight (p ​= ​0.036) and longer surgery time (p ​= ​0.044) compared with non-contaminated cases. Conclusion: Maintaining an aseptic surgical environment, particularly in trays and gowns, is essential in preventing bacterial contamination, particularly C. acnes, during joint arthroplasty procedures.

Keywords

• Peri-prosthetic joint infection
• Total arthroplasty
• Surgical field
• Bacterial culture
• Bacterial infections